How to tackle the main causes of under five and maternal mortality
If every baby were exclusively breastfed from birth, an estimated 1.5 million lives would be saved – and enhanced – every year. Breastfeeding protects babies from diarrhoea and acute respiratory infections, stimulates their immune systems and response to vaccinations, and contains hundreds of health-enhancing antibodies and enzymes.
Diarrhoea is caused by ingesting certain bacteria, viruses or parasites that are usually spread by flies or through contaminated water, food, utensils and hands. Therefore, hygiene practices such as hand washing and safe disposal of faeces go a long way in preventing diarrhoeal diseases.
Good nutrition is also critical for preventing diarrhoea. The result of multiple causes, including a lack of food, common and preventable infections, inadequate care and unsafe water, malnutrition plays a role in more than half of the nearly 11 million deaths each year of children under five years of age in developing countries.
For a family to have nutritional security, there must be access not only to food, but also to adequate care for children and women as well as to basic health services and a healthy environment. Strong child and maternal health services at the community level, therefore, contribute to reducing child malnutrition.
The importance of vital micronutrients is well established. A child deficient in vitamin A faces a greater risk of dying from common ailments such as measles, malaria or diarrhoea. Iodine deficiency is the leading cause of preventable mental retardation, and iron deficiency, by far the most prevalent form of malnutrition, is a leading cause of anaemia. Zinc deficiency in malnourished children contributes to growth failure and weakened immunity and is also thought to be associated with childbirth complications. Severe zinc deficiency results in growth retardation, diarrhoea, skin lesions, loss of appetite, hair loss and, in boys, slow sexual development. Zinc has now been shown to have a therapeutic effect on diarrhoea cases.
UNICEF invests in efforts to ensure that micronutrients are available to all children who need them, working with governments in both donor and developing countries to develop innovative programmes to deliver micronutrients in foods or through health care services.
Most diarrhoea-related deaths in children are due to dehydration – the loss of large quantities of water and electrolytes (sodium, potassium and bicarbonate) from the body in the liquid stool. Many of these deaths can be prevented with the use of oral rehydration therapy (ORT) – the oral administration of sodium, a carbohydrate and water. The current World Health Organization (WHO)/UNICEF recommendation for ORT is "increased fluids plus continued feeding.”
Acute respiratory infections (ARI)
Adequate nutrition – particularly breastfeeding – and micronutrient supplementation, including zinc, are effective in preventing ARI.
Haemophilus influenzae type b (Hib) pneumonia kills half a million children a year; it can be prevented with the Hib vaccine.
Pneumonia, one of the most common acute respiratory infections, can be treated with affordable antibiotics, since bacteria is the primary cause of infection. But it is crucial that the warning signs are recognized – a cough accompanied by difficult or short, rapid breathing – and that appropriate health care is sought immediately. Consequently, UNICEF’s main strategy to help reduce deaths due to pneumonia is through improving care-seeking behaviour for children with these signs.
Measles, a vaccine-preventable viral respiratory infection, claimed over 770,000 lives in 2001 because children were not immunized with a $0.26 vaccine. Routine immunization, including against measles, is critical to ensuring that children survive and thrive.
Measles is sometimes complicated by diarrhoea, ear infections, pneumonia or encephalitis. Children affected by measles complications may suffer lifelong disabilities, including brain damage, blindness and deafness. In areas where vitamin A deficiency is a problem, the additional loss of vitamin A caused by diarrhoea and vomiting poses a significant risk. Proper nutrition, including ORT if necessary and micronutrient supplementation, is needed in treating measles.
The use of insecticide-treated bednets is one of the most important strategies for controlling malaria. Studies have shown that under-five mortality rates could be reduced by about 25 to 30 per cent if all young children in malarial areas were protected by treated bednets at night.
Another key preventive is Intermittent Preventive Treatment (IPT). This means providing at least two doses of an anti-malarial drug (sulfadoxine-pyrimethamine) to pregnant women at each scheduled antenatal visit after the first trimester, whether they show symptoms of being infected with the malaria parasite or not. IPT has been shown to substantially reduce the risk of anaemia in mothers and low birth weight in newborns; malaria infection is a leading cause of both problems. Research shows that IPT may also be effective for infants in reducing anaemia and malaria – and this intervention may soon may be provided when children visit health services for routine immunization.
Early diagnosis and treatment of malaria saves lives and prevents the development of complications. It is important, therefore, that families seek health services and that these services, and the necessary anti-malarial drugs, are available. Widespread drug resistance against the commonly-used anti-malarial drugs, such as chloroquine, in many regions of the world means that drug treatments should follow nationally-recommended protocols. Proper home treatment of fever is also critical.
Approximately 50 per cent of all new HIV infections occur among young people. The best measures for prevention among young people involve personal choices in health and reproductive behaviour. UNICEF helps governments ensure that young men and women aged 15 to 24 have access to the information, education and services necessary to develop the life skills required to reduce their vulnerability to HIV infection. Services should include access to preventive methods such as female and male condoms, voluntary testing, counselling and follow-up.
A baby born to an HIV-positive mother has a 25 to 35 per cent chance of becoming infected during pregnancy, childbirth and breastfeeding. More than 800,000 children were infected in this way in 2002. Studies have shown that a mother-to-child intervention package, including the use of anti-retroviral drug treatment at the end of pregnancy or a single does of nevirapine given during labour and to the baby within three days of birth, can reduce the risk of transmission of HIV approximately by 50 per cent.
Counselling regarding infant feeding options can also reduce the risk of transmitting HIV from mother to child. Though HIV can be transmitted through breastfeeding, breastfeeding may nevertheless be the optimal choice a mother can make in certain situations. Counselling provides women with knowledge about the risks, benefits and costs of her various feeding alternatives so that she can make her own informed decision about how best and most safely to feed her newborn child.
Each year, about 515,000 women die of pregnancy and childbirth complications. The direct causes of maternal deaths are haemorrhage, sepsis (infections on a massive scale), obstructed labour, hypertensive pregnancy disorders, , and complications due to unsafe abortion. Every pregnant woman runs the risk of suffering from any of these complications, but there is no specific test or method to predict which women will suffer from them.
Providing emergency obstetric care is the single most effective way to reduce maternal deaths. This means facilities that are renovated, equipped, adequately supplied and appropriately staffed, and able to save lives by administering drugs and performing surgery, assisted vaginal delivery and blood transfusions. A functioning referral system to specialized services is also critical.
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